• Jeremy M Adelstein, Andrew J Moyal, John T Strony, Robert J Burkhart, David C Kaelber, Christina W Cheng, Zachary L Gordon, and Christopher G Furey.
• Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, Ohio.
• Spine. 2024 Oct 1.

Study DesignLarge database propensity-matched retrospective cohort analysis.ObjectiveThis study aimed to investigate the potential effects of serotonergic antidepressants on outcomes after anterior cervical spine surgery (ACSS). It was hypothesized that the perioperative use of serotonergic antidepressants would be associated with higher rates of hematoma formation and worse outcomes after ACSS.Summary Of Background DataSelective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been associated with worse outcomes after orthopaedic procedures.MethodsA retrospective cohort analysis was performed using TriNetX, an aggregated and de-identified electronic health record platform. Patients who underwent anterior cervical surgery were included via Current Procedural Terminology (CPT) codes and the International Classification of Disease (ICD-10) encounter diagnosis codes. Cohorts were 1:1 propensity matched across seven demographic and medical comorbidity parameters, and outcomes were compared. The incidence of adverse outcomes, as well as healthcare utilization, within 14 days, 30 days, 90 days and 2-years post-operatively was evaluated.ResultsFollowing propensity matching, each cohort consisted of 9,249 patients, for a total of 18,498 patients included in final statistical analysis. SSRI/SNRI's were associated with higher odds of hematoma formation within 7-days (0.69% vs. 0.46%, OR 1.5 [95% CI 1.02-2.2], P=0.04) and within 14-days postoperatively (0.81% vs. 0.52%, OR 1.6 [95% CI 1.1-2.3], P=0.01. Within 30- and 90-days, SSRI/SNRI's were associated with higher risk of emergency department utilization (30-day OR 1.30 [1.1-1.4]; 90-day OR 1.3 [1.2-1.4]) and irrigation & debridement (I&D) (30-day OR 1.9 [1.2-3.0]). SSRIs/SNRIs were also associated with significantly higher risk of I&D within 2-years (OR 1.3 [1.1-1.6]).ConclusionThe use of serotonergic antidepressants perioperatively was associated with higher odds and risk of numerous outcomes, including hematoma formation, emergency department utilization and the need for irrigation & debridement. Future prospective studies are required to confirm these results.Level Of EvidenceIII; retrospective cohort analysis.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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